Validation of the AFP model as a predictor of HCC recurrence in patients with viral hepatitis-related cirrhosis who had received a liver transplant for HCC

Notarpaolo, Andrea; Layese, Richard; Magistri, Paolo; Gambato, M.; Colledan, M.; Magini, Giulia; Miglioresi, L.; Vitale, Alessandro; Vennarecci, Giovanni; Ambrosio, Cecilia D; Burra, Patrizia; Benedetto, Fabrizio Di; Fagiuoli, Stefano; Colasanti, Marco; Ettorre, Giuseppe Maria; Andreoli, Arnoldo; Cillo, Umberto; Laurent, Alexis; Katsahian, Sandrine; Audureau, Étienne; Roudot‐Thoraval, Françoise; Duvoux, Christophe

doi:10.1016/j.jhep.2016.10.038

Cited by 177 publications

(178 citation statements)

References 28 publications

Supporting

Mentioning

162

Contrasting

Unclassified

Order By: Relevance

“…A competing risk analysis taking the competing risk of death unrelated to HCC showed that the AFP model performed better than the Milan criteria. The study also showed a closer association of the AFP model with predictors of recurrence on pathology of the explanted liver, such as the presence of microvascular invasion and poor differentiation . A further external validation of this model came from a study in Latin America, where the predictive capability of the AFP model was replicated, though in this population (as in the Italian population) the model was less accurate for patients with HCC and chronic HBV infection .…”

Section: Hepatocellular Carcinoma and Lt: Is It Time To Expand The Crmentioning

confidence: 81%

“…The predictive capacity of the AFP model was consistent when it was applied to patients re‐assessed after down‐staging, and in the transition from a high‐ to a low‐risk score. The model's predictive power was recently validated independently in a multicentre Italian study, in which the AFP model confirmed its ability to differentiate between patients at low‐ and high‐risk of recurrence, and their 5‐year survival in a population with mainly post‐viral cirrhosis . A competing risk analysis taking the competing risk of death unrelated to HCC showed that the AFP model performed better than the Milan criteria.…”

Section: Hepatocellular Carcinoma and Lt: Is It Time To Expand The Crmentioning

confidence: 85%

“…This model was identified using multivariate analysis on a training cohort, and validated in a more recent cohort. It includes AFP with various cut‐offs (10‐100‐1000 ng/mL) to provide a greater degree of granularity, as well as tumour number and size . A scoring system that includes these three parameters, using a simplification to obtain a two‐tiered classification (low vs high risk of recurrence) was able to differentiate between 5‐year recurrence rates (8.8% vs 50.6%, P < .001), and survival rates (67.8% vs 47.5%, P = .002).…”

Section: Hepatocellular Carcinoma and Lt: Is It Time To Expand The Crmentioning

confidence: 99%

See 2 more Smart Citations

Specific issues concerning the management of patients on the waiting list and after liver transplantation

Burra

Giannini

Caraceni

et al. 2018

Liver International

Self Cite

View full text Add to dashboard Cite

The present document is a second contribution collecting the recommendations of an expert panel of transplant hepatologists appointed by the Italian Association for the Study of the Liver (AISF) concerning the management of certain aspects of liver transplantation, including: the issue of prompt referral; the management of difficult candidates; malnutrition; living related liver transplants; hepatocellular carcinoma; and the role of direct acting antiviral agents before and after transplantation. The statements on each topic were approved by participants at the AISF Transplant Hepatology Expert Meeting organized by the Permanent Liver Transplant Commission in Mondello on 12-13 May 2017. They are graded according to the GRADE grading system.

show abstract

Section: Hepatocellular Carcinoma and Lt: Is It Time To Expand The Crmentioning

confidence: 81%

Section: Hepatocellular Carcinoma and Lt: Is It Time To Expand The Crmentioning

confidence: 85%

Section: Hepatocellular Carcinoma and Lt: Is It Time To Expand The Crmentioning

confidence: 99%

See 1 more Smart Citation

Specific issues concerning the management of patients on the waiting list and after liver transplantation

Burra

Giannini

Caraceni

et al. 2018

Liver International

Self Cite

View full text Add to dashboard Cite

show abstract

“…Duvoux et al[41] proposed a new predictive score for HCC recurrence, namely the AFP model, which assigns a score between 0-9 based on the number of nodules, maximum diameter of the largest nodule and AFP level at listing, where low-risk patients (score ≤ 2) had a 5-year survival of 68% and a recurrence rate of 9%. The AFP model was subsequently externally validated and officially adopted by the French organization Organ Sharing for HCC patients[45]. Toso et al[46,47] proposed and validated a new composite criteria including total tumor volume (TTV; ≤ 115 cm 3 ) and AFP (≤ 400 ng/mL); patients transplanted within these criteria showed an overall 5-year survival of 75% and a recurrence rate of 9%, at the cost of higher risk of dropout in comparison to patients within the Milan criteria (42% vs 25%).…”

Section: Main Issues In the Staging Of Hcc Before Ltmentioning

confidence: 99%

Liver transplantation for intermediate hepatocellular carcinoma: An adaptive approach

Biolato

Marrone

Miele

et al. 2017

WJG

View full text Add to dashboard Cite

Hepatocellular carcinoma is becoming an increasing indication for liver transplantation, but selection and allocation of patients are challenging because of organ shortages. Conventional Milan criteria are the reference for the selection of patients worldwide, but many expanded criteria, like University of California San Francisco criteria and up-to-7 criteria, have demonstrated that survival and recurrence results are lower than those for restricted indications. Correct staging is crucial and should include surrogate markers of biological aggressiveness (α-fetoprotein, response to loco-regional treatments). Successful down-staging can select between patients with tumor burden initially beyond transplantation criteria those with a more favorable biology, provided a 3-mo stability in meeting the transplantation criteria. Allocation rules are constantly adjusted to minimize the imbalance between the priorities of candidates with and without hepatocellular carcinoma, and take into account local donor rate and waitlist dynamics. Recently, Mazzaferro et al proposed a benefit-oriented “adaptive approach”, in which the selection and allocation of patients are based on their response to non-transplantation treatments: low priority for transplantation in case of complete response, high priority in case of partial response or recurrence, and no listing in case of progression beyond transplantation criteria.

show abstract

“…Currently, several biomarkers are utilized in clinical practice, but both the AASLD and an international consensus (15,20) describe biomarkers as an area of future study. Alpha fetoprotein (AFP) (21)(22)(23)(24) and proteins induced by vitamin K absence II (PIVKA-II) (25-28) have been extensively studied and validated as predictors of HCC outcomes. However, there are patients who do not produce either biomarker and still have high risk of recurrence (29,30).…”

mentioning

confidence: 99%

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

Rosenblatt

Tafesh

Halazun

2017

Transl. Gastroenterol. Hepatol.

View full text Add to dashboard Cite

Since the advent of the Milan criteria in 1996 and its widespread adoption for selection of patients with hepatocellular carcinoma (HCC) who would benefit from transplant, there has been an extensive hunt for the ideal clinical biomarker to predict HCC recurrence. This is because Milan lack does not include tumor biology indices and recurrence rates remain in the 15-20% range worldwide. While a 'silver-bullet' biomarker has not been found, several useful inflammatory markers have been identified and used in scoring systems that supersede Milan in their ability to predict HCC recurrence post liver transplantation (LT). In this review, we aim to summarize the role of inflammatory markers paly in the selection of HCC patients awaiting LT. measured characteristic to indicate a biological process or response (19). They have the potential to assess the risk of recurrence in HCC without invasive testing, offering yet another tool in a physician's armamentarium to identify the patients who would benefit from LT and those who would not. Currently, several biomarkers are utilized in clinical practice, but both the AASLD and an international consensus (15,20) describe biomarkers as an area of future study. Alpha fetoprotein (AFP) (21)(22)(23)(24) and proteins induced by vitamin K absence II (PIVKA-II) (25-28) have been extensively studied and validated as predictors of HCC outcomes. However, there are patients who do not produce either biomarker and still have high risk of recurrence (29,30). Therefore, pursuing other biomarkers that assess the role of inflammation in malignancy is another method to identify patients at risk of recurrence. The link between inflammation and cancer was postulated in the year 1863 by Virchow, and inflammation has been linked with several gastrointestinal malignancies (31). In the last decade, there has been increasing interest in the use of inflammatory markers as tools to predict poor outcomes in patients with HCC. This review will focus of such inflammatory markers, the role they play in HCC, and how to potentially use these as selection tools for patients awaiting transplant. Neutrophil lymphocyte ratio (NLR)The NLR is a measure of the proportion of peripheral blood neutrophils to lymphocytes and has an important role in predicting outcomes in several malignancies. An elevated NLR can be a marker of both neutrophilia in response to inflammation or peripheral lymphopenia, both first demonstrated the use of NLR in predicting outcomes for HCC in 150 patients undergoing LT for HCC. Of the 13 patients with elevated NLR, 62% had recurrence and, as a cohort, had significantly worse OS and RFS. Of note, even patients within Milan criteria with an elevated NLR, compared to those with normal NLR, had a significantly worse survival (30% vs. 81%) (36). In the largest study in the MELD era from the United States examining post-LT outcomes for HCC, the MORAL score was evaluated for its ability to predict post-LT RFS. The MORAL score was constructed using Cox-regression analyses for factors imp...

show abstract

Validation of the AFP model as a predictor of HCC recurrence in patients with viral hepatitis-related cirrhosis who had received a liver transplant for HCC

Cited by 177 publications

References 28 publications

Specific issues concerning the management of patients on the waiting list and after liver transplantation

Specific issues concerning the management of patients on the waiting list and after liver transplantation

Liver transplantation for intermediate hepatocellular carcinoma: An adaptive approach

Role of inflammatory markers as hepatocellular cancer selection tool in the setting of liver transplantation

Contact Info

Product

Resources

About